I

GENERAL DENTAL PRACTITIONERS

Code

Procedure description

DM/+

MP

TC

General Dental Practice

Maxillo-facial and Oral Surgery

Prosthodontics

A. DIAGNOSTIC

8101

Full mouth examination

(charting and treatment planning (see Rule 001)

B

320.72

-

-

An assessment performed on a patient to determine the patient's dental and medical health status involving an examination, diagnosis and treatment plan. It is a thorough assessment and recording of the patient's current state of oral health (extraoral and intraoral hard and soft tissues), risk for future dental disease as well as assessing general health factors that relate to the treatment of the patient. This procedure is also used to report a periodic examination on an established patient to determine any changes in a patient's dental and medical health status since a previous periodic or comprehensive examination.

No further oral examination fees shall be levied until the treatment plan resulting from this assessment is completed (See Rule 001).

8102

Comprehensive oral examination

B

418.64

-

-

An assessment performed on a new or established patient (patient of record) to determine the patient's dental and medical health status involving a comprehensive examination,diagnosis and treatment plan.

It is a thorough assessment and recording of the patient's past and current state of oral health (extraoral and intraoral hard and soft tissues), risk for future dental disease as well as assessing general health factors that relate to the treatment of the patient. A comprehensive examination includes treatment planning at a separate appointment where a diagnosis is made with information acquired through study models, full-mouth x-rays and other relevant diagnostic aids. It includes, but is not limited to the evaluation and recording of dental caries, pulp vitality tests of the complete dentition, plaque index, missing and unerupted teeth, restorations, occlusal relationships, periodontal conditions (including a periodontal charting and bleeding index), hard and soft tissue anomalies (including the TMJ). The patient shall be provided with a written comprehensive treatment plan, which is a part of the patient's clinical record and the original should be retained by the dentist.

No further oral examination fees shall be levied until the treatment plan resulting from this assessment is completed (See Rule 001)

8104

Examination or consultation for a specific problem not requiring a full mouth examination, charting and treatment planning

B

126.63

-

-

An assessment performed on a new or established patient (patient of record) involving an examination, diagnosis and treatment plan, limited to a specific oral health problem or complaint. This type of assessment is conducted on patients who present with a specific problem or during an emergency situation for the management of a critical dental condition (e.g., trauma and acute infections). It includes patients who have been referred for the management of a specific condition or treatment such as the removal of a tooth, a crown lengthening or isolated grafting procedure where there is no need for a comprehensive  assessment.

Comment: This code should not be reported on established patients who present with specific problems/emergencies which is part of and/or a result of the patients' current treatment plan, e.g. recementation/replacement of temporary restorations, pain relief during root canal treatment,etc.

Radiographs/Diagnostic imaging

8107

Intraoral radiographs - periapical

B

122.36

122.36

122.36

Eight and more radiographs of any combination of Codes 8107 and 8112 taken on the same date of service for diagnostic purposes are considered to be a complete intraoral series (8108) and should be submitted as such.

8108

Intraoral radiographs - complete series

B

920.27

975.92

975.92

A complete series consists of a minimum of eight intraoral radiographs, periapical and or bitewing, occlusal radiographs exclused

8112

Intraoral radiograph - bitewing

B

122.36

122.36

122.36

Eight and more radiographs of any combination of Codes 8107 and 8112 taken on the same date of service for diagnostic purposes are considered to be a complete intraoral series (8108) and should be submitted as such.

8113

Intraoral radiograph - occlusal

B

190.62

190.62

190.62

8115

Extraoral radiograph - panoramic

B

503.76

503.76

503.76

8116

Extraoral radiograph - cephalometric

B

503.76

503.76

503.76

8118

Extraoral radiograph - skull/facial bone

B

503.76

503.76

503.76

OTHER DIAGNOSTIC PROCEDURES

8117

Diagnostic models

+L

B

137.49

137.67

137.67

Also known as study models or diagnostic casts. Models used to aid diagnosis and treatment planning. Diagnostic models should be retained as part of the patient's clinical record and may only be used for diagnostic purposes. Includes diagnostic models mounted on a hinge articulator.

8119

Diagnostic models mounted

+L

B

353.50

353.50

353.50

See code 8117. Report this code when models are mounted on a movable condyle articulator.

8121

Oral and/or facial image (digital/conventional)

B

137.49

137.67

137.67

This includes traditional photographs and digital intra- or extraoral images obtained by intraoral cameras. These images should only be reported when taken for clinical/diagnostic reasons and shall be retained as part of the patient's clinical record. Excludes conventional radiographs.